Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.37 / $209.83 / $408.84	Facility	26	$127.37	$209.83	$408.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $286.79 / $372.31 / $883.32	Professional		$286.79	$372.31	$883.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $127.38 / $317.70	Professional	26	$86.00	$127.38	$317.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $216.86 / $266.22 / $443.16	Professional	TC	$216.86	$266.22	$443.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.44 / $539.92 / $611.91	Professional		$257.44	$539.92	$611.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.55 / $194.40 / $301.07	Professional	26	$89.55	$194.40	$301.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $167.89 / $167.89 / $167.89	Professional	TC	$167.89	$167.89	$167.89
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $1,056.00 / $1,056.00	Facility	26	$346.39	$1,056.00	$1,056.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $446.80 / $817.81 / $2,483.33	Professional		$446.80	$817.81	$2,483.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $154.31 / $266.55 / $925.20	Professional	26	$154.31	$266.55	$925.20
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $310.00 / $542.91 / $1,773.11	Professional	TC	$310.00	$542.91	$1,773.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $362.47 / $709.85 / $1,145.32	Professional		$362.47	$709.85	$1,145.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.32 / $203.56 / $355.13	Professional	26	$111.32	$203.56	$355.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $240.31 / $519.60 / $803.95	Professional	TC	$240.31	$519.60	$803.95
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $123.71 / $254.79 / $539.79	Facility	26	$123.71	$254.79	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $420.85 / $852.08 / $1,487.86	Professional		$420.85	$852.08	$1,487.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.74 / $236.61 / $309.55	Professional	26	$109.74	$236.61	$309.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $321.77 / $615.47 / $1,232.82	Professional	TC	$321.77	$615.47	$1,232.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.59 / $274.36 / $658.21	Professional		$57.59	$274.36	$658.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $183.70 / $222.12 / $226.46	Facility	26	$183.70	$222.12	$226.46
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $140.29	Professional		$140.29	$140.29	$140.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $145.34 / $196.47 / $238.29	Professional	26	$145.34	$196.47	$238.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $356.32 / $493.00 / $641.52	Professional	TC	$356.32	$493.00	$641.52
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $151.30 / $151.30 / $152.63	Facility	26	$151.30	$151.30	$152.63
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $511.89 / $782.19 / $1,001.46	Professional		$511.89	$782.19	$1,001.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $173.21 / $258.52 / $313.56	Professional	26	$173.21	$258.52	$313.56
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $338.68 / $517.52 / $698.58	Professional	TC	$338.68	$517.52	$698.58
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $464.31 / $685.08 / $1,025.36	Professional		$464.31	$685.08	$1,025.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $154.31 / $230.18 / $309.02	Professional	26	$154.31	$230.18	$309.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $310.00 / $459.90 / $712.00	Professional	TC	$310.00	$459.90	$712.00
United Facility/Professional Professional Modifier Low / Median / High Price $310.75 / $547.03 / $1,001.10	Professional		$310.75	$547.03	$1,001.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.77 / $126.95 / $319.20	Professional	26	$102.77	$126.95	$319.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $207.98 / $415.97 / $692.48	Professional	TC	$207.98	$415.97	$692.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $372.67 / $372.67 / $372.67	Professional		$372.67	$372.67	$372.67
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $117.82 / $117.82 / $117.82	Professional	26	$117.82	$117.82	$117.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $254.85 / $254.85 / $254.85	Professional	TC	$254.85	$254.85	$254.85